USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 1 of 11
[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 20-10466
Non-Argument Calendar
________________________
D.C. Docket No. 1:17-cv-22309-MGC
CARMEN MARIA GARCIA,
Plaintiff-Appellant,
versus
COMMISSIONER OF SOCIAL SECURITY,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Southern District of Florida
________________________
(November 3, 2020)
Before WILSON, JORDAN, and NEWSOM, Circuit Judges.
PER CURIAM:
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 2 of 11
Carmen Garcia appeals the district court’s order affirming the
Administrative Law Judge’s (ALJ) denial of her application for supplemental
security income (SSI). On appeal, Ms. Garcia argues that the ALJ (1) failed to
articulate the weight assigned to her psychiatrist’s treatment notes and rejected the
same psychiatrist’s medical opinions without good cause; (2) failed to properly
assess Ms. Garcia’s paragraph B criteria ratings and residual functional capacity
(RFC); and (3) failed to properly assess the credibility of her subjective statements
and complaints. After careful review, we affirm.
I. STANDARD OF REVIEW
We review de novo the ALJ’s application of legal principles, and we review
the ALJ’s resulting decision “to determine whether it is supported by substantial
evidence.” Moore v. Barnhart,
405 F.3d 1208, 1211 (11th Cir. 2005) (per curiam).
Substantial evidence is more than a scintilla, but “less than a preponderance.”
Id.
It is “such relevant evidence as a reasonable person would accept as adequate to
support a conclusion.” Winschel v. Comm’r of Soc. Sec.,
631 F.3d 1176, 1178
(11th Cir. 2011). This limited review does not permit us to decide the facts anew,
make credibility determinations, or reweigh the evidence.
Moore, 405 F.3d at
1211.
2
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 3 of 11
II. DISCUSSION
A. Dr. Tauler’s Medical Opinions
Ms. Garcia argues that the ALJ failed to properly consider the medical
opinions of her treating psychiatrist Dr. Antonio Tauler, and that the ALJ lacked
good cause to accord less than substantial or controlling weight to Dr. Tauler’s
opinions. We disagree.
Eligibility for SSI requires the claimant to be disabled. 42 U.S.C.
§ 1382(a)(1)–(2). In assessing whether the claimant is disabled, the ALJ will
consider medical opinions, which are statements from physicians, psychologists,
and other acceptable medical sources that reflect judgments about the nature and
severity of the claimant’s impairments and what the claimant can still do despite
the impairments.
Winschel, 631 F.3d at 1178–79.
In determining what weight to give a medical opinion, the ALJ considers
several factors, including: (1) the examining relationship; (2) the treatment
relationship, including the length and nature of the relationship; (3) the
supportability of the opinion; and (4) the consistency of the opinion with other
evidence. 20 C.F.R. § 404.1527(c)(1)–(4) (2016).1 Generally, the Social Security
Administration (SSA) gives “more weight” to an opinion from a treating source
1
All citations to the C.F.R. will be to the 2016 version unless otherwise noted.
3
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 4 of 11
because these sources are “likely to be the medical professionals most able to
provide a detailed, longitudinal picture” of the claimant’s medical impairment.
Id. § 404.1527(c)(2). Indeed, if the SSA finds that a treating source’s opinion on
the nature and severity of an impairment is “well-supported by medically
acceptable clinical and laboratory diagnostic techniques and is not inconsistent
with the other substantial evidence” in the record, the SSA will give the opinion
“controlling weight.”
Id.
And even where the treating physician’s opinion is not entitled to controlling
weight, it must be given substantial or considerable weight unless “good cause” is
shown to the contrary.
Winschel, 631 F.3d at 1179. We have found good cause to
exist where: (1) the opinion was not bolstered by the evidence; (2) the evidence
supported a contrary finding; or (3) the opinion was conclusory or inconsistent
with the doctor’s own medical records.
Id.
The ALJ must also clearly articulate his reasons for giving less weight to a
treating physician’s opinion, and the failure to do so is reversible error. Lewis v.
Callahan,
125 F.3d 1436, 1440 (11th Cir. 1997). However, “there is no rigid
requirement that the ALJ specifically refer to every piece of evidence in his
decision, so long as the ALJ’s decision . . . is not a broad rejection” that leaves the
district court or us with insufficient information to conclude that the ALJ
considered the claimant’s medical condition as a whole. Dyer v. Barnhart, 395
4
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 5 of
11
F.3d 1206, 1211 (11th Cir. 2005) (per curiam). We will reverse only if the ALJ
“fails to state with at least some measure of clarity the grounds for his decision.”
Winschel, 631 F.3d at 1179 (internal quotation mark omitted).
Here, the ALJ did not commit reversible error in his articulation of the
weight accorded to Dr. Tauler’s treatment notes. Although the ALJ did not refer to
each of Dr. Tauler’s treatment notes, his decision illustrates that he considered the
content of the notes and explained “with at least some measure of clarity” the
grounds for discounting Dr. Tauler’s medical opinions.
Id. Thus, we find no
reversible error in this regard.
Further, the record reflects that the ALJ had good cause to give Dr. Tauler’s
opinions less than substantial or considerable weight. The ALJ acknowledged Dr.
Tauler’s treating relationship with Ms. Garcia but found that his opinions were
exaggerated and inconsistent with his own treatment notes and other record
evidence. For instance, Dr. Tauler’s medical source statements provided that
Garcia was utterly unable to function independently or socialize, but the treatment
notes, as well as an August 2013 interview with Ms. Garcia’s brother and a
September 2013 psychological examination by Dr. Wanda Romero, showed that
she could do so to a greater extent than what Dr. Tauler described. As the ALJ
noted, the record evidence showed that she was able to care for her three
grandchildren, socially interact with family, attend social functions, and
5
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 6 of 11
independently make appointments. Thus, the ALJ had good cause not to give
substantial or considerable weight to Dr. Tauler’s opinions, and substantial
evidence supported his decision.
Id. Accordingly, we affirm in this respect.
B. Paragraph B Criteria and Residual Functional Capacity
Ms. Garcia further claims that the ALJ failed to properly assess her
paragraph B criteria ratings and RFC at steps three and four of the sequential
evaluation. Upon review, we conclude that the ALJ’s determinations were
supported by substantial evidence.
Social Security regulations outline a five-step, sequential evaluation process
to determine whether a claimant is disabled. See 20 C.F.R. § 404.1520(a)(1). The
ALJ must evaluate whether: (1) the claimant engaged in substantial gainful
activity; (2) the claimant has a severe impairment; (3) the severe impairment meets
or equals an impairment in the Listing of Impairments; (4) the claimant has the
RFC to perform past relevant work; and (5) in light of the claimant’s RFC, age,
education, and work experience, there are other jobs the claimant can perform.
Phillips v. Barnhart,
357 F.3d 1232, 1237 (11th Cir. 2004). If the ALJ determines
that the claimant is not disabled at any step of the evaluation process, the inquiry
ends. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4).
Here, the ALJ found at step one that Ms. Garcia had last engaged in
substantial gainful activity in August 2013. At steps two and three, the ALJ found
6
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 7 of 11
that Ms. Garcia’s major depressive disorder was a severe impairment, but not one
that met or equaled the level of severity of a listed impairment. At step four, the
ALJ found that Ms. Garcia had the RFC to perform simple work that requires
limited personal interaction. Finally, the ALJ determined at step five that although
Ms. Garcia was unable to perform any of her past relevant work, there were jobs
she could perform in the national economy. Therefore, the ALJ concluded that
Ms. Garcia was not disabled.
Ms. Garcia contests the ALJ’s findings as to her: (1) Paragraph B criteria
ratings at step three; and (2) RFC at step four. We address each in turn.
1. Paragraph B Criteria
At step three, a claimant is conclusively presumed to be disabled if she
meets or equals the level of severity of a listed impairment, or Listing. Crayton v.
Callahan,
120 F.3d 1217, 1219 (11th Cir. 1997). To meet a Listing, the claimant
must meet all of the specified medical criteria, and an impairment that fails to do
so does not qualify, no matter how severely it meets some of the criteria. Sullivan
v. Zebley,
493 U.S. 521, 530 (1990). The claimant bears the burden of
demonstrating that she meets a Listing. Barron v. Sullivan,
924 F.2d 227, 229
(11th Cir. 1991).
To meet Listing 12.04 for affective disorders, a claimant must meet the
requirements in both paragraphs A and B, or meet the requirements in paragraph C.
7
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 8 of 11
20 C.F.R. pt. 404, subpt. P, App. 1, § 12.04. Paragraph B requires that the
medically documented persistent syndrome result in at least two of the following:
(1) marked restriction of activities of daily living; (2) marked difficulties in
maintaining social functioning; (3) marked difficulties in maintaining
concentration, persistence, or pace; or (4) repeated episodes of decompensation,
each of extended duration.
Id. § 12.04(B). “Marked” means “more than moderate
but less than extreme,” and occurs when the degree of limitation seriously
interferes with a claimant’s ability to function “independently, appropriately,
effectively, and on a sustained basis.”
Id. § 12.00(C).
Here, the ALJ reviewed each of the four paragraph B functional limitation
criteria and concluded that Ms. Garcia did not have marked limitations or repeated
episodes of decompensation on at least two of the criteria. First, the ALJ
determined that Ms. Garcia had only mild restriction of her daily living activities
because she had at least some ability to cook, garden, clean, and care for her
grandchildren. Second, the ALJ determined that Ms. Garcia had moderate
restriction of her social functioning because despite her complaints of social
isolation, she demonstrated the ability to use public transit and to socialize with her
family. Third, although Ms. Garcia reported difficulties in maintaining
concentration, persistence, or pace, the ALJ found her difficulties to be only
moderate because she exhibited at least some ability to concentrate when
8
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 9 of 11
examined. This finding comported with Dr. Romero’s opinion that while Ms.
Garcia had some trouble completing complex tasks and concentrating, she was
able to follow simple instructions and demonstrated at least fair ability to
concentrate. Last, the ALJ found that Ms. Garcia had not suffered from repeated
and extended episodes of decompensation.
The record reflects, therefore, that the ALJ considered Ms. Garcia’s
testimony and weighed it against other record evidence in finding that she did not
have marked limitations or repeated episodes of decompensation on at least two
paragraph B criteria. While some evidence in the record may have supported more
severe limitations, the ALJ determined that the record as a whole weighed against
Ms. Garcia’s claims. Because substantial evidence supported that determination,
the ALJ did not err on step three.
2. Residual Functional Capacity
At step four, the ALJ must determine a claimant’s RFC by considering all
relevant medical and other evidence.
Phillips, 357 F.3d at 1238. The RFC is “that
which an individual is still able to do despite the limitations caused by his or her
impairments.”
Id. The claimant’s RFC is then used to determine her capability for
performing various designated levels of work (sedentary, light, medium, heavy, or
very heavy). See 20 C.F.R. § 404.1567. Here, after considering the record as a
whole, the ALJ determined that Ms. Garcia could perform work at all exertional
9
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 10 of 11
levels, with the nonexertional limitation that she could perform only simple work
requiring limited personal interaction.
This determination was supported by substantial evidence. The ALJ’s
decision reflects careful consideration of the August 2013 interview with Ms.
Garcia’s brother, Ms. Garcia’s own testimony, the content of her treatment records,
and the effectiveness of medication in controlling her impairments. Again, while
some evidence may have weighed against the ALJ’s determination of Ms. Garcia’s
RFC, substantial evidence supported the ALJ’s conclusion when considering the
record as a whole. Accordingly, we affirm in this respect as well.
C. Ms. Garcia’s Credibility
Ms. Garcia argues last that the ALJ failed to properly assess her credibility.
Yet upon review, we determine that the ALJ’s assessment of Ms. Garcia’s
credibility was supported by substantial evidence.
A claimant attempting to establish disability through his or her own
testimony of subjective symptoms must show: “(1) evidence of an underlying
medical condition; and (2) either (a) objective medical evidence confirming the
severity of the alleged pain; or (b) that the objectively determined medical
condition can reasonably be expected to give rise to the claimed pain.” Wilson v.
Barnhart,
284 F.3d 1219, 1225 (11th Cir. 2002) (per curiam). The ALJ may
10
USCA11 Case: 20-10466 Date Filed: 11/03/2020 Page: 11 of 11
discredit the claimant’s subjective testimony, but “he must articulate explicit and
adequate reasons for doing so.”
Id.
Here, substantial evidence supported the ALJ’s determination that Ms.
Garcia’s subjective complaints about her symptoms and limitations were not fully
credible. After comparing Ms. Garcia’s testimony with evidence that she had
performed a wide range of daily activities, had cared for her grandchildren, and
had no psychiatric hospitalizations, the ALJ found that the objective evidence was
inconsistent with Ms. Garcia’s testimony and that her impairments were less severe
than she claimed. Because the ALJ articulated explicit and adequate reasons for
discrediting Ms. Garcia’s testimony, his decision to grant little probative weight to
her testimony was not reversible error.
Id. Accordingly, we affirm the ALJ’s
decision.
AFFIRMED.
11
